Burns MCQs

The overall effect of these changes is to produce a net flow of water, solutes and proteins from the intravascular to the extravascular space. This flow occurs over the first 36 hours after the injury, but does not include red blood cells. In a small burn, this reaction is small and localised but, as the burn size approaches 10-15% of total body surface area (TBSA), the loss of intravascular fluid can cause a level of circulatory shock. Furthermore, once the area increases to 25% of TBSA, the inflammatory reaction causes fluid loss in vessels remote from the burn injury. This is why such importance is attached to measuring the TBSA involved in any burn. It dictates the size of inflammatory reaction and therefore the amount of fluid needed to control shock. Reference : Bailey & Love's short practice of surgery, chapter: 46, Edition: 28 th , Pg: 666

Key features of escharotomy placement. Upper limb - Mid-axial, anterior to the elbow medially to avoid the ulnar nerve Hand - Midline in the digits. Release muscle compartments if tight. Best done in theatre and with an experienced surgeon Lower limb - Mid-axial. Posterior to the ankle medially to avoid the saphenous vein Chest - Down the chest lateral to the nipples, across the chest below the clavicle and across the chest at the level of the xiphisternum General rules extend the wound beyond the deep burn. Diathermy any significant bleeding vessels. Apply haemostatic dressing and elevate the limb postoperatively Reference : Bailey & Love's short practice of surgery, chapter: 46, Edition: 28 th , Pg: 673

Marjolin's ulcer: is a squamous cell carcinoma arising from Chronic burns scar Keloid scar Long standing venous ulcer scar Chronically inflamed wounds are susceptible to neoplastic transformation. Squamous cell carcinoma was originally reported in chronic burn scars by Marjolin . Chronic osteomyelitis, pressure sores, venous stasis ulcers, and hidradenitis may also develop neoplastic change. Biopsies should be performed in cases of chronic wounds that appear clinically atypical. Cutaneous wounds may first exhibit pseudoepitheliomatous hyperplasiaa premalignant condition. Such a diagnosis on biopsy should prompt additional biopsies to exclude squamous cell carcinoma, which may already be present in other areas of the wound.

Answer- B. First degree burn First degree burn (also k/a Superficial or Epidermal burn) These burns involve only the epidermis They do not blister, Are erythematous because of dermal vasodilation Blanch to touch (i.e. show capillary refilling) Are quite painful Heal without scarring in 5 to 10 days. They result in pain and reddening of the epidermis (outer layer of the skin). The clinical fearures are blistering and/or loss of the epidermis. The underlying dermis is pink and moist. The capillary return is cleariy visible when blanched